TY - JOUR
T1 - Decreased costs and retained QoL due to the 'PACE Steps to Success' intervention in LTCFs
T2 - Cost-effectiveness analysis of a randomized controlled trial
AU - Wichmann, Anne B.
AU - Adang, Eddy M.M.
AU - Vissers, Kris C.P.
AU - Szczerbińska, Katarzyna
AU - Kylänen, Marika
AU - Payne, Sheila
AU - Gambassi, Giovanni
AU - Onwuteaka-Philipsen, Bregje D.
AU - Smets, Tinne
AU - Van Den Block, Lieve
AU - Deliens, Luc
AU - Vernooij-Dassen, Myrra J.F.J.
AU - Engels, Yvonne
AU - Andreasen, Paula
AU - Barańska, Ilona
AU - Bassal, Catherine
AU - Moore, Danni Collingridge
AU - Finne-Soveri, Harriet
AU - Froggatt, Katherine
AU - Hammar, Teija
AU - Heikkilä, Rauha
AU - Hockley, Jo
AU - Honinx, Elisabeth
AU - Van Hout, Hein
AU - Kijowska, Violetta
AU - Ten Koppel, Maud
AU - Kuitunen-Kaija, Outi
AU - Leppäaho, Suvi
AU - Mammarella, Federica
AU - Mercuri, Martina
AU - Miranda, Rose
AU - De Paula, Emilie Morgan
AU - Van Den Noortgate, Nele
AU - Oosterveld-Vlug, Mariska
AU - Pac, Agnieszka
AU - Pasman, H. Roeline W.
AU - Pautex, Sophie
AU - Payne, Sheila
AU - Piers, Ruth
AU - Pivodic, Lara
AU - Rossi, Paola
AU - Szczerbińska, Katarzyna
AU - Segat, Ivan
AU - Van Der Steen, Jenny T.
AU - Stodolska, Agata
AU - Tanghe, Marc
PY - 2020/9/22
Y1 - 2020/9/22
N2 - Background: The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the 'PACE Steps to Success' intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries. Methods: A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures. Results: Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018). Conclusions: Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective. Trial registration: ISRCTN14741671.
AB - Background: The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the 'PACE Steps to Success' intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries. Methods: A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures. Results: Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018). Conclusions: Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective. Trial registration: ISRCTN14741671.
KW - Cost-benefit analysis
KW - Nursing homes
KW - Palliative care
KW - Teaching
UR - http://www.scopus.com/inward/record.url?scp=85091473056&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12916-020-01720-9
DO - https://doi.org/10.1186/s12916-020-01720-9
M3 - Article
C2 - 32957971
SN - 1741-7015
VL - 18
JO - BMC medicine
JF - BMC medicine
IS - 1
M1 - 258
ER -